Loading...
HomeMy WebLinkAbout0071 WAKEBY ROAD - Health 71 WAKEBY ROAD _ MARSTONS MILLS A = 043 025i i 0 } y TOWN OF BARNSTAB,LE COCA ON ^Y Q SEWAGE VII,LAGE m f����a ti Vh� I ASSESSOR'S MAP & LOT O5'3-0 zS— rn Q� INSTALLER'S NAME&PHONE NO: fl ' S- i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 4z�6 i7 T , 1 B(JIL,DER OR OWNER) rw '- [(--LO-© i COMPLIANCE PERMIT DATE: DATE: y `Z 7 ra.1 `i Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist i. Feet ' on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet.of leaching facility) Furnished by —, � f - r `) I \ �CD c\ Commonwealth of Massachusetts 3 Executive Office of Environmental Affairs Department ofhd "' Rf�� Environmental Protecti FFa Ei�E4 w MITI 1 om F.Weld d j0 4. 199�Twd xs AMso Paul Callucci y B 4'Tyqq NSTg9 David hs U.Gommor OfPT if SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION � PART A _ CERTIFICATION Property Address: 71 Wakeby Rd, Marstons Mills, MAAddressofOwner.. Maureen Santos Date of Inspection: (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sews-e disposal systems. The system: -L sge pa s v-.Y.' _ C6nditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails qq, Inspectoe's Signature: G v , Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] SYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. ] SYSTEM CONDITIONALLY PASSES: m One or more syste components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02106 • FAX(617)556-1049 • Telephone(617)292-5500 ice,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddrem 71 _Wakeby Rd, Marstons Mills , MA Owner. Maureen Santos Date of Inspection ;L^9 SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution boa is levelled or replaced The system required pumping more than four times.a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. S) OTHER (revised 11/03/95) 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 71 Wakeby Rd, Marstons Mills , MA Owner. Maureen Santos Date of Inspection: 2- D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last 9ear NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARD SYSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owner or rator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements o 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST property Addrem 71 Wakeby Rd, Marstons Mills, MA Owner. Maureen Santos Date of Inspection: ;._. Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. _`done of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _✓As built plans have been obtained and examined. Note if they are not available with N/A. �he facility or dwelling was inspected for signs of sewage back-up. 'The system does not receive non-sanitary or industrial waste flow _L/he site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _61Ae septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. _U14he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION property Address: 71 Wakeby Rd, Marstons Mills, MA Owner. Maureen Santos Date of Inspection: FLOW CONDITIONS RESIDENTIAL.• Design flow 3 3 0 sallons Number of bedrooms: A-3 Number of current residents: Garbage grinder(yes or no):A- ® Laundry connected to system(_yes or no): � Seasonal use(yes or no)::' 0 Water meter readings,if available: 1995 - 36, 000 gals 36, 000 gals Last date of occupancy: A C+ COMMERCIAL/INDUSTRIAL:- Type of establishment: Design flow:_gallons/day Green trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Lest date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pt&ped as part of inspection: (yes or no)A-O If yes,'volume pumped: gallons Reason for pumping: TYPE O YSTEM Septic tank/dWi ribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: I //Z S Sewage odors detected when arriving at the site: (yes or no) A P) (revised 11/03/95) b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 Wakeby Rd, Marstons Mills, MA Owner. Maureen Santos Date of Inspection: X -07—cc SEPTIC TANIQL/ (locate on site plan) Depth below grader Material of construction: Va'oncrete_metal_FR.P_other(e:plain) Dimensions: 1< Sludge depth: !`a-- Distance from top of sludge to bottom of outlet tee or baffle:,f b Scum thickness: 9 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: -2..-3' Comments: (recommendation for pumping,condition of inlet and outlet tees-or,baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) I U b ® C, ,o f .41 ' Q S G/4--'.o st s ,a, G._ �nnet� . 7� G E TRAP:_ (loca on site plan) Depth below grade: Mate of construction:_concrete_metal_FRP_other(ezplain) Dim nsions: thickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Co eats: ( ndation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, avid nce of leakage,etc.) — 144 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 Wakeby Rd, Marstons Mills , MA Owner. Maureen Santos Date of Inspection: �L_ _ /D TI OR BOLDING TANK:_ (kxx_ site plan) Depth grade: Material of construction:_concrete_metal_FRP_other(explain) - ns: Capacity. ons Design gallons/day Alarm 1 1: Commen (conditio of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert:1 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) j:�� � PUMP HAMBER:_ (locate o site plan) Pumps' working order:(yes or no) Co rn (no 'tion of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrees: 71 Wakeby Rd, Marstons Mills, MA Owner. Maureen Santos Date of Inspection: 2--'i -cj I SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if poemble;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number: leschiag chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Conte:Inate condition of soil,signs of hydraulic failure, level of pon ' condition of vegetation etc tZ 0 ,6 d o c=0/ i A T-- 6 A r=. C PooLs: (loca on site plan)) i and configuration: pth- p of liquid to inlet invert• pth f solids layer. Depth and layer: ns of cesspool: Mate of construction: tion of groundwater: inflow(cesspool must be pumped as part of inspection) Commen : (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY:_ (locate n site plan) Materials f construction: Dimensions: Depth of so' Comments: condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 71 Wakeby Rd, Marstons Mills, MA Owner. Maureen Santos Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ., DEPTH TO GROUNDWATER Depth to groundwater:,/0Q '�- feet y� method of determination or approximation: to V J (revised 11/03/95) 9 g . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills ,� MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: V Shawn Mcelroy ` Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally,inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-9-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. o t5ins•3/13 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Pag 1 17 L Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND),for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or�uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced .❑ Y ❑, N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15:303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Tige 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) = 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: r D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less® than %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you.have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No _ ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system corponents, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth cif liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): 2 • DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information , Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy 5-2015. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information 6 + i Pumping Records: Source of information: Owner--pumped 2009 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): , t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspectionform Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M , 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd ` Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1 k 3" Distance from top of scum to top of outlet tee or baffle 6" 11 Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan):_ Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. h Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The old pit was still in operation and empty at inspection. The new leach chambers were empty at inspection with no visible stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form Not for Voluntary Assessments' G1M , 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of,hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15. page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Aj_�,P�7 - Ir ® "Y' id-i'l 9` Af .P ... � ? f .er R 33 6-6 - f k t5ins-3t13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I L Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope. t ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: I ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established,the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 71 Wakeby Rd Property Address Pamela Kittredge Owner Owner's Name information is required for every Marstons Mills MA 02648 5-9-15 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 •�" rt• FRONT ELEVATION LEFT ELEVATION ArrA es ? TM"r REAR ELEVATION FIR — 11 A 'A 8 � ! A •ereraxoATe• A A A wuww�w.o"¢wru arse wme••eA -- ---------- I L�jKj-rrCHENOl I /A•.o. ' '� - } •To•n. ° r...a.•w.,nwe• w r 1 CwRAW.nAI.Sw,P• ACE NEW D SUNROOM ew,e"_ ee /o• °' I ie^Ae• A i i elru:l e•.I rei ANCHOR BOLT DETAIL rrn� SCALE:VI'-1'-0" I Oft— ,n•wre" a .MA,"He n°of��65�.��«e.. LIVING naurw cee,e•wpm• n°�. :°,m uKAr"w�.iomn "a.me �E K u•,ow@.W�n o* BASEMENT e �o DETAIL AT WALL A • *.a.D A ROOF FRAMING PLAN A wre• .re.n• N A A ^�"^•••�" FOUNDATION PLAN NQTE6, NOTES: VNI.IEfiS OTHERI SE NOTED"te'• 2.)USE BIWSON H2 81 HUMCANE OJM •� 1.)CONTRACTOR ISTO VERIFY ALL EX16rING CONUMONS AT ALL RAFTERS ENDS FIRST FLOOR PLAN 2 eD MENSON9IN THE FIELD 3.1 MNMOTER TYPE LAYCUT amRuec �em TYP.ROOF CONST. . CONTRACTOR TO VERIFY ALL INTERIOR b EXTERIOR MATERIALS, /OwNERB DETNLS.b FENISHESIN THE FIELD WITH OWNER LEGEND: e.)ROUGHOFENINGHEAO HEIG),TOFWNCOWSAT TYP.WALL CONST. •re ::::/o:. "wr°a FIRST FLOOR TO BE 6111"ABOVE SLISIFLOOR I , oe�... '•ew% o<euxaec Q EXISTING WALLS i.)ALL CONSTRUCTION TO CONFORM TO MO CMR MASSACHUSETTS m�Al° •,ru w"ie - - [-:3 CONSTRUCTION TO BE REMOVED STATESUILCING LODE.BrHEDI7IONAMENDEMENr&tRC2(09 xavawru•n: g irtu�rwrn. O NEWCONSTRUCTION 8.) 110MFFIE)Y SUREBWINDZONF. — •ecwno xvueA•rA•°• SUNROOM ',u,,°�"ourF1u:neme•n.'rz". b)ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, ORHORIZONTALLYWBLOCHING AT EDGES,6"EDGFJI2"MELD NAIUNO •vaeo Tvvuw•wu•oAx/uto IECC2O15 RESIDENTIAL 71 ENERGY EFFICIENCY DETAILS ALL LVL lUM6ER/BEAMS T0�1.Ba L9W LOAD r.r.a.n et>... w't11PB0M Na"^t° 1E Zor°enee ert�R mesa+vmev^uresO 8,)SEE CERTIFIED FLOT PLAN DEVELOPED BY WARNICN ASSOCIATES ' 6° " i•atE mat.anmruN vaEacwonve lrsuumN•rgtegrvAn MReoulErreNrn FOR ALL PROFO6mbEXISTINGDETNLS NEW i�"e4uria�P�% u S.) FOLLOWALL MANUFACTURER';SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS yIti„m„ •"• CRAWLSPACE 10.)ALL CONCRETE USED FOR FOUNDATION WALLS.FOOTNOSb GLASS ream omuere rootu••wa.•xeT TO BE2000PSI e°mntt®� coea�oi • 7-1 11.1 VERIFY ALL PLIJMRNG b ELECTRICAL DETAIL;W/OWNERS ON THE EITE wi sw'nur•w ,z ocon r Aeu°rmrw•e DURING FRAMING CONSTRUCTION A,(TwTAr°"•.10^*wencxu•N" mwure••xarerao",.•wu.ezre•o• 12.)TIMBERFRAMINGTOBESP FJRNEUFIR NO,2GRADE roL:•" wow" (;)BUILDING SECTION SUNROOM •"1p0^w^w"eUT°" 1S.)FOLLCW ALL REOUIREMENTSOF THE 110 MPH CHECKLISTSUPPLIED TYP.DECK DETAIL uroa.NRa���. BQ®COTUITBAYDESIGN.LLC NEW ADDITION/REMODELING FOR: SCALE: DRAWING NO.: 43 BREWSTER ROAD °1 1/4° MASH PEE MA.O2Bae gLANCHETTE RESIDENCE MA(eDa)r�A 2 DATEAl AKEBY RD. MARSTONS MILLS MA •"w�1RORe� a"7/�17 71 W f TOWhi F ARNSTAB'L> c�K eC�i SSWAOE Y VXLLAGE. 4� SSE5aoR°S MAl'&.Lour 1ST LLER'S NAME 8t 0lol=fE No SHIMC TAW WICAPACITY.. IOC. qa s Lg,Acl-amp pA,Cury, ( �) ROOMS NO.OFTIED 7 . 3�JT1'DER OR M'F�t -- PE I E"Cf�l�'��. CC11�r to N `1"►ATE—.— Stiff ratioe►) M11mce T Oftet1F eel Gibe: Mnx�inum lIjustcrl Graut�ilwtet`l' 61e In firealtott ui X�s;uGhtn�t�i�cildy .::. .� .. Poly 3c:�`lttt4r Su lyly Pc l futcl Y giohlag Pacfty any reifs e:xtsi r� o eetG oe evbthip FAO feet'ok leaowoo facility) Ecl�,is<yff V►1�t9aad aiid lLeacfnin�Fa011ty f uiy atctla145 e Mil9laItt.iQ(1 feetP�lecu:hitig aclliry) r:_ wd� '� ire i � Rlser , 0 rf CZ C/ G —3�t�rr �� /.7 o a -F 33`14 t TOWN OF BARNSTABLE - LOCATIO o3 q "it QO SEWAGE # y/ Z y 3 VILLAGE 11101-3. c N tM%r t __ __ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.MA w J11 a z L '»S'- Z 3 SEPTIC TANK CAPACITY c,Al . LEACHING FACILITY: (type) Z: A), � �( ize) NO.OF BEDROOMS 4�6 BUILDER OR PERMITDATE:�ZI -Zo—©I COMPLIANCE DATE: Y `Z"7—ol Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ..Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet . Furnished by `\� � / � � � ��� v� ",.:. � � r a �. �� � `� ,'4. ��,j ��, . , V' F�� _ - ',. �.y No.. Fee $ 5 0. / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Migoga.r *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )UpgradeXX)Abandon( ) O Complete System El Individual Components Location Address or Lot No. 71 ' Wakeby Road Owner's Name,Address and Tel.No. Marstons Mills,Mass. 02648 David Jean P.O.Box 443 Assessor'sMap/Parcel 6 e 3 0 -� J— Osterville,Mass. 02655 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-7 7 5-3 3 3 8 J.P.Macomber & Son Inc. J.P.Mac6mber & Son Inc. Box 66 Centerville,Mass. 02632 1Box 66 Centerville,Mass.02632 Type of Building: DwellingXXX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 2 X 1 1 0=2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existinq 1 000 tank Type of S.A.S.Pxi sti nq 1 _T.P_1 0000 Description of Soil LOamy sand tn f i nP sand Mature of Repairs or Alterations(Answer when applicable) W l l, install 2-5 0 0 gallon eaching chambers packed in 4 of f3 stone. 25 'X13 'X2 ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by th' 13?W Health. Signed Date 4/1 9/01 Application Approved by Date Lo 0 Application Disapprove or the following reasons Permit No. C13 Date Issued Ll-Z'a.0 1 ft, No. c q� .:.. Fee $ 50.0 i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes PUBLIC ZfppYication for ;Siopogar bracm Construction errn t Application for a Permit to Construct( )Repair( )Upgrade*X)Abandon( ) ❑Complete System El Individual Components Location Address or Lot No.781 Wakeby Road Owner's Name,Address and Tel.No. Marstons Mills,Mass. 02648 David Jean P.O.Box 443 Assessor'sMap/Parcel O Osterville,Mass. 02655 lr .� Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No-5 0 8-7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macdmber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelli4XX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No-of Persons Showers( Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 2 X 1 1 0=2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1000 tank Type of S.A.SJ3xistina 1 —LP-10000 Description of Soil Loamy sand to fine sand ac�h° R6p in 0 c�Yiam6ers°pacwar hen3pplicle)1 Stofl§tE� �a 13X2 .* Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ed by t s KHeal Signe Datel4/19/01 Application Approved by � Date y- Application Disapprove or the following reasons 4 Permit No. � Z y Date Issued y-2,.p'0 -------------------=------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired�X )Upgraded( ) Abandoned.( )byJ.P.Macomber & Son Inc. 71 Wakeby RoadMarstons Mills,Mass. ' at -: has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Perm`rt Nd �� 3 dated '/-7-o- O Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & Son Inc. The issuance of this Perri shall not be construed as a guarantee that the syst ill fu etio s design Date Y/ Z 7�o Inspector s No. '�c/V/' �--� -----O G� -------------FQ$50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS Xigpozat *pgtem Construction Permit Permission is here lZ ranted to Construct( )Repair t X )Upgrade( )Abandon( ) System located at 7f Wakeby Road Marstons M111s,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru ctio npust b�completed within three years of the date of tlu� ' Date: Approved by l/&99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P.Madomber Jr., hereby certify that the application for disposal works construction permit signed by me dated 4/19/01 . concerning the property located at 71 Wakeby Road Marstons Mills.Mass.meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system , • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable) • I.f the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will M be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation 5b +the MAX. High G.W. Adjustment DDYERENCE BETWEEN A and B SIGNED : DATE: 4/, 1 9/01 (Sketch on back), q:hWth folder,een ` 1 S /V CB/DH FOUND rn a Qo _ o Wgk£eY ROAD CATCH BASIN o 1J 81A PAVEMENT z PROJECT LOCATION CB/DISC PAYMENT BQ31.3 ata e FOUND. DMH BENCHMARK: R O AD/ Qz 81.7 ED NAIL & CAP { 8 416 VADE) EL 81.56 2 81.5 81:6 ',b LR� ' K c Q CATCH PQp A L..v Y CATCH s1.2 BASIN �PP"�i 18-4 / LOCUS MAP CATCH PAVEM BASIN 1 0 /� `� NOT TO SCALE 1 81.6 EDG F 1.3 BASIN ❑ �� ���82" \�� TEL + UY� / ❑ N85 0 27 EJ s2.s R 780.00 1C�9.81' �� � I , r+81.7 LEGEND I L 15.19 '- � J / FOUND I \ w sz.s -- 82 ---- EXIS77NG 2' CONTOUR 80 EXIS77NG 10' CONTOUR 82.7 +81.3 EXISTING SPOT ELEVATION LQT 6 o I i LOT 7 PP U77UTY POLE V I N/F DHM 00 OST AV RNL FENCE S I o DRAIN MANHOLE o llz"Nr L. 1�NNL'IJY CB/DH El co 82.7 sz.� I zo FOUND CONCREIL� BOUND LAWN ow Q, \Z9 82.9 BRICK w V 80.9 80.9 52.9' 82.z CK m i GENERAL NO TES: RI AIC. B 80A NEW 81.5 3 STONES 1. HOUSE NUMBER: 71 � o z. 80 v EXISTING 82.1 ;a HOUSE Nam, �g2� 2. ASSESSORS INFORMA 770N: MAP 043, PARCEL .025, LOT 6 w F.F. 84.77 N � 81.8 J. FLOOD ZONE X PANEL: 250001 0541 J (0 711 612 0 1 4) .M N O Z HOT DECK 42 0 m TUB SHED 4. ZONING DISTRICT.• RF 7.8 z o \ So.s 1.s C E _ _82- LAWN 8 5. OVERLAY DIS7RIC7S• WELLHEAD PROTECTION DISTRICT & RESOURCE PR07EC77ON DISTRICT m \ LOT 5 I 2.1 o EXISTING 6. LOT COVERAGE BY N/1f' �<q m N SEPTIC SYSTEM n Z A. EXIS77NG S7RUC7URES.• 979 S F./ 20,024 S.F. = 4.9% S'ILSAN BL'THfL n / j p (LOCATION v +77.4 / APPROXIMATE) r, B. EXIS77NG & PROPOSED S7RUCTURES.• 1,050 S.F./ 20,024 SF. - 5.2% / LAWN t° / to I m 7. TOPOGRAPHIC INFORMA 77ON COMPILED FROM AN ON THE GROUND SURVEY �' -�� � & ELEVA77ONS SHOWN ARE BASED ON NORTH AMERICAN VER77CAL DATUM 1988 / 80.0 01 ^CO / +81.3 / U= 84. S/TE PLAN �84.1 ST CK FENCE . CB/D SC A E FOUND FOR E 15 2.74! STOCKADE AL & SUE BLANCHETTE #71 WAKEB Y ROAD CB/DH FOUND LOT 15 MARSTONS MILLS, MA F N ' LOT 18 .8MA ' R L'D.4NS N/F Jflef"'L L. Scale: 1 "=20' Dote: AUGUST 8, 2017 MRISTINL' 0. RIMY �P�SH OF A4,gSs 4 GARYS.LABRIOym Warwick & Associates Inc. O U NO.40039 y DRANIV 011A. G.M., R.sAW. DA7E 08108117 Q/ T o 88 County Road Box 801 s 20 o 10 20 40 bNA o North Falmouth, &ass OW558 OVECICED BY.' G& .9iffT 1 CIS 1 lfj ^� (508) 563 - 7777 P.'11-0"d PmjWts 20iO4 jSS17044 jd0V j$$170,"W dW9 SCALE >/NCH = 20 FEET / 11/ L r